Dieter Riemann

From Early to Late Adulthood Changes in EEG Sleep of Depressed Patients and Healthy Volunteers

In order to evaluate the impact of aging on EEG sleep patterns we investigated the polysomnograms of 74 patients with major depression and 51 healthy volunteers aged 18-65 years. In most of the EEG sleep parameters, age-related changes were obvious in both the depressives and the normals. In the patients, some of these alterations occurred earlier and were more pronounced. The amount of slow-wave sleep decreased with age, but no differences were found between the depressives and the healthy volunteers at any particular age. Rapid-eye-movement (REM) latency was clearly affected by age, but there were no significant differences between patients and controls until the middle of the fourth decade of life. On the other hand, REM density measures did not vary with age and were increased in the depressives. Therefore, REM density appears to be a more likely candidate for a biologic marker for major depression than is REM latency.

Initial REM sleep suppression by clomipramine: A prognostic tool for treatment response in patients with a major depressive disorder

Kupfer et al. (1976, 1981) demonstrated, in a sample of 82 depressed patients, that the amount of rapid eye movement (REM) sleep suppression during the initial 2 nights of treatment with amitriptyline correlated positively with clinical response. Gillin et al. (1978) were able to replicate this finding in six depressed patients. From these results, it may be speculated that polysomnographic measurement of REM sleep in patients during the initial nights of treatment with ~tidepressive drugs may offer the possibility of improving drug therapy. Whereas in clinical practice the response to antidepressive medication can only be evaluated after at least 10-14 days of medication (Woggon 1983), the predictive value of REM sleep changes may allow us to avoid unsuccessful treatment early in the course of therapy. The above-cited studies raise the question of whether or not it is possible to establish the threshold of initial REM sleep suppression necessary for successful drug therapy, thereby providing a substantial differentiai-therapeutic tool that could influence the choice of drug or dosage. The aim of the present

EEG sleep and the cholinergic REM induction test in anorexic and bulimic patients

The electroencephalographic (EEG) sleep of 20 anorexic patients, 10 bulimic patients, and 10 age-matched healthy controls was studied. In addition, six anorexic patients and six bulimic patients had a cholinergic rapid eye movement (REM) sleep induction test (RIT) performed with the cholinergic agent RS 86. The three samples showed no major differences in sleep patterns. The same held true when attention was focused on patients who additionally met DSM-III criteria for major depression. The RIT results were similar in the patients with eating disorders and in controls, but differed from those reported in depressives. Therefore, the present study found no hints of depression-like sleep patterns in patients with eating disorders.

A polysomnographic study in young psychiatric inpatients: major depression, anorexia nervosa, bulimia nervosa

The baseline EEG sleep patterns of 10 young depressed patients, 20 patients with anorexia nervosa, 10 patients with bulimia nervosa, and 10 healthy subjects were found to be indistinguishable, except for an increased REM density in the depressed patients. In eating disorder patients, a concomitant major depressive episode had no influence on EEG sleep. The results of the cholinergic REM sleep induction test revealed a significantly faster induction of REM sleep in the depressed patients when compared with the eating disorder patients and the control subjects. This indicates a subthreshold hypersensitivity of the REM sleep triggering cholinergic transmitter system in depressives, but not in eating disorder patients.

Is there a relationship between response to total sleep deprivation and efficacy of clomipramine treatment in depressed patients

Abstract— Total sleep deprivation (TSD) and tricyclic medication are successful treatment modalities for patients with a major depressive disorder. Recent studies have suggested a positive relationship between TSD response and succeeding tricyclic treatment, even on a very specific level, thus supporting the assumption of two distinct biochemical subtypes of depression. The present study tested this hypothesis by treating 10 inpatients with a major depressive disorder first with TSD and succeedingly with clomipramine. Contrary to expectation, a negative relationship between clinical response to the two treatment modalities was found.

Sleep and dreams in eating disorders.

The results of several studies on sleep EEG and dreams in patients with eating disorders are presented and compared with the data obtained in patients with a major depression. The sleep pattern, which is characteristic of depression, could not be found in the eating disorder group. Regarding the cholinergic REM induction test, the depressive displayed a pronounced shortening of REM sleep latency. However, this biological marker, indicating a cholinergic hyperactivity in depression, could not be observed in patients with eating disorders. The content analysis of laboratory-recorded dreams yielded several differences between depression and eating disorders and also, more subtle, between anorexia and bulimia.

Reversal of Antidepressant Sleep Deprivation Effects by Daytime Naps

Total sleep deprivation (TSD) is an effective treatment of major depression, with a response rate of about 50% - 60%. In contrast to other antidepressant treatments, the therapeutic effect develops rapidly, but a relapse into depression virtually always occurs after the following nocturnal sleep (Gerner et al. 1979; Gillin 1983; Kuhs and Tolle 1986).

HLA-DR2 and sleep onset REM periods in depression

References Baidessarini ILl (1985): Drugs and trealment of psychiatric disorders. In Goodman Gilman A, Goodman LS, Rail TW, Murad F (eds), Goodman and Gilmans The Pharmacological Basis of Therapeutics, (7 ed.) New York: Macmillan Publishing Co, pp 38%445. Feighner JP, Herbstein J, Damlouji N (1985): Combined MAOI, TCA, and direct stimulant therapy of treatmentresistent depression, d Clin Psychiatry 46:206-209. Krisko I, Lewis E, Johnson JE (1960): Severe hyperpyrexia due to tranylcypromine mnphetamine toxicity. Ann Intern Med 70:559.

Verbesserung der Lebensqualität durch Akzeptanz und CommitmentTherapie

Bei Insomnie ist die Akzeptanz- und Commitment-Therapie (ACT) möglicherweise eine geeignete Behandlungsmethode, vor allem zur Verbesserung der schlafbezogenen Lebensqualität. Eine Pilotstudie erbrachte erste Hinweise auf die Wirksamkeit bei Patienten mit schwerer chronischer Insomnie, die auf eine störungsspezifische kognitive Verhaltenstherapie nicht respondiert hatten.

Neue Studien zu Schlafstörungen

Professor Dieter Riemann und Kollegen erläutern, welche Auswirkungen die im aktuellen DSM-5 veränderten Klassifikationen im Bereich der Insomnie haben, und wie man den Aufwand für die kognitive Verhaltenstherapie der Insomnie reduzieren kann. Sie stellen zudem eine Metaanalyse vor, die erstmals die Veränderungen der Schlafkontinuität und Schlafarchitektur bei Patienten mit Insomnie mittels Polysomnografie bestätigt, und fassen Daten zu einer neuen Therapieoption zusammen.